State's overdose plan underwhelms experts

“If as many whales had died on the coast of the Cape as people have died (of drug overdoses) in Stoughton, every naturalist in the world would be here trying to figure out what happened with the water.” -- Dr. Barbara Herbert, chief of addiction medicine, St. Elizabeth’s Medical Center

Last fall, John Greene’s 19-year-old son, Evan, spent 40 days in jail for failing a drug test while on probation.

Greene, an Easton resident, had been trying to get through to his son about opiate and heroin addiction for years, so jail time was in some ways a relief.

Evan was released on Dec. 23 with a follow-up court date of Jan. 22.

On Jan. 16, Evan Greene died of a drug overdose.

He is among nearly 200 people who have died of suspected drug overdoses in the last four months, according to state police data that does not include the commonwealth’s largest cities.

The spike in deaths led Gov. Deval Patrick last week to declare a public health emergency.

Patrick called for an increase in treatment funding and tightened prescription drug controls, and said he would make the overdose-reversal drug Narcan more widely available.

But the governor’s announcement – coming in the midst of a decade-long battle against opiate addiction – represents an incomplete picture of what can be done to fight the epidemic, say doctors, public officials and families touched by addiction.

They point to a variety of ways in which the state could make additional strides, such as expanding drug courts, improving overdose investigation and truly limiting excessive narcotic prescriptions.

“What are the most imaginative things we can do?” said Dr. Barbara Herbert, chief of addiction medicine at St. Elizabeth’s Medical Center in Brighton.

“If as many whales had died on the coast of the Cape as people have died in Stoughton, every naturalist in the world would be here trying to figure out what happened with the water,” she said.

For John Greene, his son’s death this winter is a tragic example of how the criminal justice continues to fail addicts and their families.

After Evan Greene was arrested with two friends in 2011 for stealing jewelry from an Easton home, he landed on probation. One supervisor was lax, his father said, but then he got a new supervisor, who violated his probation based on a drug test result.

Evan was released from jail in December under the supervision of the first officer.

“It was all on him,” Greene said of his son. “I don’t know what can be done.”

One thing that can be done, according to Brockton Mayor Bill Carpenter, is to dramatically expand the drug court system in Massachusetts.

There are currently 19 drug courts throughout the state. They have been established to divert people into substance-abuse treatment programs rather than jail or prison.

Page 2 of 3 - Carpenter said he is glad for the heightened attention, but that it’s all in the follow-through. For instance, mandating that doctors use a prescription drug-tracking system will only be effective if the attorney general aggressively prosecutes problem doctors, he said.

“It’s long overdue,” Carpenter said. “We’ve been dealing with this drug epidemic in Brockton for 10 years.”

Dr. David Rosenbloom, professor of health and policy management at Boston University, said Patrick is “saying the right things,” but that time will tell if there is enough political will to make a difference.

“The reality is that making Narcan available and saving someone’s life is not the same as getting someone into treatment,” Rosenbloom said.

New insurance laws mandate that addiction treatment be covered like other medical treatment, Rosenbloom said, but the state has not set reimbursement rates high enough to create an incentive for medical providers to expand care.

“That is critically important,” he said. “There are effective ways to treat people. It is a combination of money and will.”

Dr. Dan Muse, an emergency room physician at Signature Healthcare Brockton Hospital, said that mandating the use of the prescription drug-tracking system will help to identify problem doctors and patients, but will not fix those problems.

“The whole system has to change,” he said. “Patients are leaving hospitals much quicker. You can’t monitor their pain as well so you make sure they have enough pain medication. At the same time, patients are rating doctors. … We have to be allowed to say no.”

Cathy Gilmore knows the problems of over-prescribing all too well.

A commuter train in Norwood killed her 27-year-old son Anthony last September, just 23 minutes after he was released from the hospital for a drug overdose.

“If we could get the doctors to stop freely writing prescriptions, you’d see a big, big difference,” Gilmore said.

After months of legal wrangling with the transit police, Gilmore finally received her son’s accident report last week.

Like John Greene, Gilmore said there was no investigation by state or local police into her son’s overdose and drug use, and that she only has a report now because Anthony’s death involved the commuter rail.

“If you get stung by a bee and get an EpiPen, you have to go to the hospital,” Gilmore said, drawing a contrast to the lack of follow-up procedures surrounding overdoses.

State police are investigating whether the powerful prescription drug fentanyl has been mixed in with heroin, as well as other possible reasons for the spike, but a backlog of thousands of cases at the state drug lab has stalled answers.

Page 3 of 3 - “If these things were going on in another disease, there’d be a whole bunch of investigative bodies figuring out what happened to cause it,” Rosenbloom said.